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Background The use of Self-Expandable metallic stents (SEMS) as a non-surgical alternative for palliation of advanced esophageal cancer (EC) is increasing. However, there is a scarcity of real-life experience on the use of these stents exclusively in oesophageal cancer. The aim of this study is to evaluate the efficacy of SEMS in inoperable esophageal cancers in the western region of Saudi Arabia. Methods A retrospective review of SEMS placed in a tertiary referral hospital for histological proven inoperable EC from 2012 until 2015. Demographics data, procedure success, complication, re-intervention and mortality were analyzed. Results 46 SEMS were placed in 35 patients for palliation of dysphagia. Median age of patients was 68 years (range 31 - 95). 69% (24) patients have lower third of EC and the rest have middle third (IDDF2021-ABS-0129 Table 1). SEMS was placed successfully in all cases with symptomatic improvement. No major stent-related complication seen. 28% (13) patients required re-intervention with additional SEMS placement, 9 of which were for tissue in growth and 4 for distal migration. Median survival was 114 days (range 30 – 498). Most of the complications seen in fully covered SEMS compared to the partially covered 50% (8/16) vs 17% (5/30), respectively p = 0.04 (IDDF2021-ABS-0129 Table 2). Chemo and/or radiotherapy were given to 51% (18) of the patients without any significant benefit on survival (p = 0.79) or re-intervention rate (p = 0.47) compared to those who did not. Conclusions SEMS is effective in palliating dysphagia in inoperable EC without major complications. Rates of tumor in-growth and migration were comparable to other studies. SEMS provides long-term palliation.

e15586 Background: In Saudi Arabia, the incidence of colorectal cancer has been increased over the past few years. The optimal treatment beyond the second line is not fully understood. To the best of our knowledge, the efficacy and disease outcomes of triflurodine/tipiracil in Saudi patients with refractory metastatic colorectal cancer(mCRC) has not been studied yet. Our study is a real-life practice evaluation of the efficacy of triflurodine/tipiracil in patients with refractory mCRC. Moreover, the prognosis and the prognostic significance of the different clinical variables have been analyzed. Methods: A retrospective, multi-centers ( 5 centers representative of Saudi Arabia )observational study in patients with mCRC who have received triflurodine/tipiracil beyond oxaliplatin & Irinotecan-based chemotherapy between December 2018-December 2020.We aimed to assess the response to triflurodine/tipiracil, to evaluate the progression-free survival (PFS ), the overall survival (OS), and the associated factors of prognostic significance. Results:The data of 100 patients with refractory mCRC who has received triflurodine/tipiracil have been analyzed. The mean age was 55.2 +11.8 years. Forty-two patients were (42%) females and 58 (58%) were male patients. Sigmoid was the most common primary site of cancer in 35 (35%) patients, followed by rectum 29 (29%). Peritoneal metastasis was present in 17 (23.3%) patients ,liver in 51(56.6%) and lung in 39 (50.7%). Metastatic sites were ≥ 2 in 45 (45%) patients. Metastatic lesions were ≥ 5 in 65 (65%) patients. Xelox chemotherapy regimen was the most commonly used first-line chemotherapy which represents 43%, while Folfiri or Xeliri combination was the most used second line in 57 (60%). For the third line, Folfox or Xelox was used in 81 (83.5%) patients. The fourth line was given to 49 (67.1%). For first-line biological agents, Cetuximab was used most frequently 31 (46.3%).Evaluation of the response to treatment with triflurodine/tipiracil revealed one patient (1%) with a complete response,3 patients (3%) with partial response, 28 (28%) patients with stable disease, and 66 (66%) showed progressive disease. The estimated median progression-free survival was 5 months ( 3.839 - 6.161) and the median overall survival was 12 months (9.732-14.268). The log-rank analysis showed that the baseline neutrophils ≤ 75 % ( P-value= 0.0092) and low hemoglobin level (P-value= 0.0245) were strongly associated with a higher survival. By multivariate Cox regression analysis, the neutrophil count ≤ 75 % was the only independent predictor for survival. Conclusions: Trifluridine/tipiracil is effective in patients with refractory mCRC. The low neutrophil count might predict a better overall survival.